Imaging Planning Research Articles

The significance of multidetector computed tomography in planning of hiatal hernia surgery

The significance of multidetector computed tomography in planning of hiatal hernia surgery

Computed tomography in planning of the treatment of complications after pancreatic surgery

Aim. To evaluate opportunity of computed tomography in diagnosis and decision making in patients with pancreatic surgery complications and possibility of interventional procedures in its treatment.Materials and methods. 50 patients underwent pancreatic surgery in 2018-2020 (45 Whipple procedure and 5 distal pancreatectomies). 45 patients underwent computed tomography in post-surgery course. The complications occur in 29 patients; complications were found by computer tomography in 26 patients.Results. The most frequent complication was pancreatic fistula (24%) in typical places: upper edge of the pancreatojejunostomy (25%) and in the bed of the resected pancreatic head (50%). Delineated fluid collections on computed tomography scans were more prevalent in patients with complicated course (57.9% vs. 26.3%). The average size of fluid collections was increased in the group of complicated courses (51,9 × 28,1 mm vs. 42,2 × 20, 6 mm). Interventional procedures were performed in 18 patients (62% of complicated patients). The average number of such interventions per patient was 2.95. Using interventional techniques as the only method of surgical treatment, 13 patients were cured (50% of complicated patients). In 14 patients, interventions were planned and performed based on control computed tomography. Postoperative bleedings were detected in 8 patients (16%). In 4 cases it revealed ongoing bleeding by computer tomography, in 3 cases – completed, which allowed us to determine further treatment tactics.Conclusion. Performing computed tomography after pancreatic surgery allows to identify postoperative complications before their clinical manifestation and plan their treatment. The optimal time for performing computed tomography is 5–6 days after surgery. Performing CT angiography for suspected bleeding in some cases allows to avoid invasive angiography and choose the method of endovascular hemostasis in appropriate situations. The combination of various interventional techniques allows to avoid relaparotomy in most patients with intraabdominal complications.

Does rectum and bladder dose vary during the course of image-guided radiotherapy in the postprostatectomy setting?

To assess the variations in actual doses delivered to the rectum and bladder in the course of postprostatectomy radiotherapy using kilovoltage-cone-beam computed tomography datasets acquired during image-guided radiotherapy. Twenty consecutive patients treated with intensity-modulated or intensity-modulated arc therapy to the prostate bed were retrospectively evaluated. Both the planning tomography and kilovoltage-cone-beam computed tomography were acquired with an empty rectum and a half-full bladder. Target localization was performed on the basis of soft tissue matching using cone-beam computed tomography scans before each treatment fraction. A total of 16 cone-beam computed tomography scans per patient (acquired at the first 5 fractions and twice weekly thereafter) were used for the assessments. The bladder and rectum were re-contoured offline on each cone-beam computed tomography scan by a single physician, and the delivered doses were recalculated. The variations in certain dose-volume parameters for the rectum and bladder (BD2cc, RD 2cc, V40%, V50%, V60%, V65%) were analyzed using the paired t test. Most of the dose volume variations for rectum and bladder were significantly higher than predicted (P <0.05) for the 320 kilovoltage-cone-beam computed tomography sets, except for the doses received by 2 cc of the bladder and V50 and V60 of the rectum. The dose-volume parameters of the bladder did not meet our criteria of V65 ≤25% and V40 ≤50% in 10% and 20% of the patients, respectively. None of the dose-volume histograms showed rectal V65 ≥17%; however, the rectal V40 ≤35% dose constraint was not met in 11 patients. For all patients, the ANOVA test revealed no significant difference between the variations. Actual doses delivered during treatment were found to be higher than predicted, but the majority of calculated bladder and rectal doses remained in the limits of our plan acceptance criteria. Interfraction variability of the rectum and bladder is a major concern in the postprostatectomy radiotherapy setting, even when patients are instructed about rectal and bladder preparation before the radiotherapy course. Image guidance with cone-beam computed tomography at each treatment fraction may offer a viable tool to account for interfraction variations of the rectum and bladder throughout the treatment course.

Subject to empowerment: the constitution of power in an educational program for health professionals

Empowerment and user participation represents an ideal of power with a strong position in the health sector. In this article we use text analysis to investigate notions of power in a program plan for health workers focusing on empowerment. Issues addressed include: How are relationships of power between users and helpers described in the program plan? Which notions of user participation are embedded in the plan? The analysis is based on Foucault's idea that power which is made subject to attempts of redistribution will re-emerge in other forms. How this happens, and with what consequences, is our analytical concern. The analysis is contrasted with 'snapshots' from everyday life in a nursing home. The program plan communicates empowerment as a democracy-building instrument that the users need. It is a tool for providing expert assistance to the user's self-help. User participation is made into a tool which is external to the user him-/herself. Furthermore, the analysis shows that the plan's image of empowerment presupposes an 'élite user' able to articulate personal needs and desires. This is not very applicable to the most vulnerable user groups, who thereby may end up in an even weaker position. By way of conclusion, we argue that an exchange of undesirable dominating paternalism for a desirable empowerment will not abolish power, but may result in more covert and subtle forms of power that are less open to criticism. The paper offers insights that will facilitate reflections on the premises for practising empowerment-oriented health care.

Use of the three-dimensional computer tomography in planning of the laparoscopic adrenalectomy

The analysis of possibilities of a three-dimensional computer tomography in an estimation of topografo-anatomic mutual relations in a surgical intervention zone is carried out at tumorous formations of adrenals in 20 cases.

Multiplanar reconstructions of helical computed tomography in planning of atlanto-axial transarticular fixation

The objective of this study was to determine atlanto-axial bone morphometric measurements related to screw transarticular fixation technique. One hundred helical computerized tomography (helical CT) scans with volumetric acquisition, including the first and the second cervical vertebrae, were studied. The screw insertion axis according to the Magerl technique for C1-C2 transarticular fixation was the referential to select the correct oblique axial and oblique parasagittal planes obtained with multiplanar reconstruction (MPR) on helical CT. The selected measured parameters on each side of the vertebrae were C2 interarticular isthmus height and width, optimal screw length, optimal screw trajectory sagittal and axial angles, and the distance between the ideal screw trajectory and the vertebral artery groove. C2 interarticular isthmus height measured 7.75+/-1.27 mm, C2 interarticular isthmus width 7.94+/-1.72 mm, optimal screw length 39.03+/-2.81 mm, optimal screw trajectory sagittal angle 57.54+/-5.28 degrees , optimal screw trajectory medial angle 7.90+/-4.05 degrees. Isthmus narrowing under 5 mm (height and/or width) was seen in 5% of cases. In 30% of cases reconstructed parasagittal images showed the vertebral artery groove. In those cases, the distance between the vertebral artery groove and the ideal screw path was measured. This distance measured under 2.5 mm in 7% of C2 articular masses. A classification of C2 articular mass morfology was proposed. The C2 articular masses without anatomic variations predisposing to vertebral artery injury were considered type I. The C2 articular masses potentially associated with vascular injury (12%) were classified as type II. Potential risk was identified at the C2 isthmus only (3%), at the anterior portion of C2 articular mass only (7%) or at both regions (2%). According to selected criteria 18% of patients would have at least one side C2 articular mass with potential risk for the vertebral artery. In 6% of patients the potential risk was identified bilaterally. There is a great variation in the maximum and minimum values of the anatomic measurements. Therefore preoperative CT scans are very important to identify type II cases, such that the surgeon may preoperatively define the bony anatomy trough which the screws will pass.